New Dementia Vision to improve the lives of people living with dementia and their carers

The quality of life for people living with dementia and their carers in Shropshire, Telford and Wrekin is set to be transformed thanks to a new, more personalised and joined-up service model being launched in the county. 

The model aims to provide people living with dementia, the support and resources they need in order to live their life to its fullest – and as they choose to.

Badged as the Shropshire, Telford and Wrekin Dementia Vision, the strategy has been informed by lived experience – of those who live with dementia and those caring for people with dementia. 

It will entail a number of changes to the current provision available and seeks to drive through changes that put the person living with dementia, their family and carer at the centre of their care. The aim is to help them live longer, more fulfilling lives in the community for as long as possible.

The model also aims to ensure there is an increased knowledge and awareness within General Practices across the county.

The new model will see the introduction of new patient-facing roles in Shropshire, Telford and Wrekin’s Integrated Care System (ICS) including Admiral Nurses – a role that currently exists in Telford but is currently being recruited for in Shropshire. In Shropshire, Admiral Nurses will provide psycho-social and practical support for people affected by dementia, when they are facing difficulties. 

Another new role to be introduced as part of the vision are Dementia Navigators, who will support people living with dementia to develop their own Living Well plan and they will be a contact point for advice, guidance and access to more help, if required. 

A number of Dementia Link Workers will also be appointed to work in the county, provided by the Alzheimer’s Society. They will support individuals living with dementia by helping them to remain socially engaged and active in their communities. They will also help contribute to the individual’s Living Well Plan, which will be introduced as part of regular reviews. These plans will be kept up-to-date and relevant for the individual.

The Dementia Vision will see all local health and care partners working in a more joined-up system, through sharing information and working as one multi-disciplinary team. This also means that the NHS will work even closer with local care homes in order to provide appropriate care and support for residents. 

Other changes include swifter assessment following the patient’s initial referral, the facilitation of peer support groups in the county, as well as more in-depth annual dementia reviews, which will place an emphasis on social aspects, as well as a clinical review of the patient.

George Rook, Chair of the Shropshire, Telford and Wrekin Dementia Steering Group, said: “As a person living with dementia myself, I know that those of us living with it and our family members and carers want to have as good a quality life as we can.

“So, the Shropshire, Telford and Wrekin Dementia Vision is about ensuring that people will be treated in an individualised way, and the services will be tailored to their needs.

“This vision is not a pathway as such – it’s a box of services and support, which people affected by dementia can dip into and use as and when they need them. 

“There is no single route for the dementia journey; people can decline quickly or slowly, in steps or gradually, and people can improve for a time during the journey. So, support and care services need to be agile and flexible to allow people affected by dementia to receive what they need, when they need it.”

Frances, Sutherland, Head of Transformation and Commissioning for Mental Health, Learning Disability and Autism for Shropshire, Telford and Wrekin Clinical Commissioning Group (CCG), added: “The Shropshire, Telford and Wrekin Dementia Vision is going to make a huge difference to the quality of life for people living with dementia in Shropshire, Telford and Wrekin.

“One of the brilliant things about the vision is that it’s been co-produced with people living with dementia and their carers.

“There’s a great deal of change to come, so understandably implementation will take time – it’s going to take at least two to three years to fully implement but that’s good because each phase will be introduced a step at a time, which will ensure each new service or resource is bedded in properly and thoughtfully. “

Councillor Andy Burford, Cabinet Member for Adult Social Care and Health, Integration and Transformation at Telford & Wrekin Council, said: “This vision has been created to improve the lives of almost 4,500 people living with dementia in Shropshire, Telford and Wrekin, as well as their family and carers.

“We are confident that this new model of care will ensure that those who need it will be able to access the help and support they need, when they need it.”

Councillor Simon Jones Cabinet Member for adult social care and public health, Shropshire Council, added: “We are proud to say that all of us working within the local health and care system will work more closely together in a more joined-up approach thanks to the introduction of the new vision, through information sharing and team work. The NHS and care homes will work collaboratively to ensure the highest standards of care and support for residents.”

Below is a visual outlining the Shropshire, Telford and Wrekin Dementia Vision – and how those living with dementia and their carers can ‘pick their own’ support, tailored to their individual needs.